With an implementation that has as many twists and turns as a plumber's snake, the success of the Affordable Care Act remains deeply uncertain. Tech crews are working through the Thanksgiving weekend to meet President Barack Obama's goal that the sign-up on the healthcare.gov website will be less glitchy by the end of November.
Add to that complication the millions of cancellation notices sent by health insurers to policy-holders whose coverage was deemed substandard under Obamacare. Although the president urged insurance companies to permit a one-year re-extension for such policy-holders, state insurance commissions in Arkansas, California, Indiana, Massachusetts, Minnesota, Mississippi, New York, Vermont, Rhode Island and Washington are refusing to comply.
Yet both critics and supporters of Obamacare agree that enlisting young and uninsured college-age Americans to buy into the features of the Affordable Care Act will be crucial to its ultimate success or failure.
Diametrically opposed advocacy groups dubbed Young Invincibles and Generation Opportunity are each working to "educate" members of this demographic group about their health insurance options. Uninsured college students are often left without much guidance in making health decisions.
These advocacy groups focus much of their time and attention on persuading college students either to purchase insurance through healthcare.gov or to buy insurance elsewhere (which may or may not comply with the Affordable Care Act), or to forgo purchasing insurance and pay the penalty fee that Obamacare imposes on those who fail to comply with the law.
Supporting Obamacare
The group Young Invincibles is targeting adults between the ages of 18-34, encouraging them to comply with the individual mandate of the Affordable Care Act and cajoling members of this generally healthy demographic group to buy insurance through the recently established health information exchanges.
"For the vast majority of uninsured young people, they're going to get a better deal through healthcare.gov," said Aaron Smith, co-founder and executive director of Young Invincibles. "The reason is because of the subsidies that are available."
To determine if they qualify for subsidies, young adults can use the subsidy calculator of the Henry J. Kaiser Family Foundation. Most student will qualify for subsidies because of their low incomes. Therefore, Smith believes that - once educated - young people will purchase insurance on the exchanges.
Looking to the experience in Massachusetts under the state health care reform signed by former Gov. Mitt Romney - which also imposed a mandate on individuals who failed to purchase insurance - Smith believes that Obamacare will be a success. Smith said that less than 2 percent of the population in Massachusetts failed to purchase health insurance. That's because the state took an active role in educating people about how the system worked.
"Massachusetts did a really good job of explaining to people and getting the word out about how the system works," Smith said. "Folks haven't looked at [healthcare.gov] because there have been problems with the website. They haven't yet gotten all the information to make the best decision."
Panning Obamacare
In contrast to Young Invincibles, the group Generation Opportunity believes that fewer college students will qualify for subsidies than is generally advertised. Generation Opportunity, a national nonpartisan organization advocating for the interest of Millennials ages 18-29, believes that young people should shrug their shoulders at Obamacare and just pay any penalty fee, if necessary.
"We're not just encouraging people to go uninsured," said Generation Opportunity spokeswoman Corie Whalen. "For young, relatively healthy people, it doesn't make any financial sense for them to pay more for less, which is what you're seeing when you compare what's offered on the Obamacare exchanges to what's actually offered on the private market."
Generation Opportunity says that young adults and college students should buy lower-priced health insurance of the sort that had been deemed substandard until Obama's about-face earlier in November. Most of these policies were destined for cancellation by the end of 2013, but may now be available in certain states until the end of 2014.
By the beginning of 2015, as the Obamacare mandate currently stands, individuals must either pay a $95/annual penalty or purchase a type of health insurance policy that has been approved by the administration. Approved insurance plans must cover these 10 essential benefits: maternity care, outpatient care, inpatient care, trips to the emergency room, prescription coverage, mental health coverage, lab tests, preventative services, pediatric services and services or devices for injuries, disabilities and chronic conditions.
Requiring young students to purchase policies that cover all 10 benefits raises the cost of health care. Whalen said students will likely have better care, cheaper insurance and won't have their private medical information on government records if they shun Obamacare.
"There are plenty of options outside of the Obamacare exchanges, which is something that Obamacare advocates don't really want to talk about, because they need young people to sustain their whole concept of the exchanges," Whalen said.
Not fitting in
Both Young Invicibles and Generation Opportunity are touring college campuses around the country. Of the 21.8 million college students attending college this fall, the majority are still eligible to stay on their parents' insurance due to the Affordable Care Act. However, those that are 26 or older no longer qualify to be on their parents' insurance.
Students like Aarick Carlson, who just received notice that he's been accepted to the College of Optometry at Pacific University, is one such student. He's 26 years old and will lose his student health plan after he graduates from BYU-Idaho in December. While he plans on buying the student health plan offered at Pacific University, he will have to wait until August to do so, which means he and his wife will have to make the decision before January to buy insurance for him through HealthCare.gov or possibly pay the $95 fee.
"I feel a lot of people are in a similar suit that I am and I haven't been educated on all aspects of this issue," Carlson said. "I think I'll probably have to end up paying the opt-out fee because I really wouldn't have any other options of health insurance for our situation."
Even some of these students that paid for health insurance through their schools are not completely immune to the changes wrought by Obamacare. CBS New York reported that community colleges in New Jersey ceased offering student health plans because they would have had to charge their students considerably more.
Impact on student plans
Schools like the University of Utah and Brigham Young University either require or encourage their students to have health insurance. The student health plans they offer have seen little change under Obamacare.
"We're allowed under the Affordable Care Act regulations that have come out subsequently since the original law to stay in our current status until 2015," said Aaron Larson, the assistant director of BYU Health Services.
Prices for student health plans at the University of Utah have gone up about 8 percent because of the ACA, according to Kerry Hill, immunization requirement and student health insurance program manager.
Other colleges like Salt Lake Community College and Utah Valley University may not offer student health plans, but they do offer resources on their websites and encourage students to be insured.
Young Invincibles and Generation Opportunity share one common message: uninsured students need to do their homework and research all options for themselves.%3Cimg%20src%3D%22http%3A//beacon.deseretconnect.com/beacon.gif%3Fcid%3D122732%26pid%3D46%22%20/%3E